Will Payers Cover Nursing Services for Wound Care?
Kathleen D. Schaum MS

$3.95 		Advances in Skin & Wound Care: The Journal for Prevention and Healing
November 2001 
Volume 14  Number 6
Pages 290 - 291
 
  PDF Version Available!

ABSTRACT
© 2001 Lippincott Williams & Wilkins, Inc. Volume 14(6)             November/December 2001             pp 290-291 Will Payers Cover Nursing Services for Wound Care? [Departments: Payment Strategies]

Schaum, Kathleen D. MS

Kathleen D. Schaum, MS, is Director, Strategic Business Development for Wound Care Strategies, Inc, Harrisburg, PA.

Ms Schaum can be reached for questions and consultations by calling 561-964-2470 or through her E-mail address, kdschaum@woundcarestrategies.com.

Submit your questions for Payment Strategies by mail to Kathleen D. Schaum, MS, 6491 Rock Creek Drive, Lake Worth, FL 33467.

Information on payment is provided as a service to our readers, but does not guarantee that payment will be provided. Providers are responsible for case-by-case documentation and qualification for payment.

Q: I am a registered nurse, and I recently received board certification in wound, ostomy, and continence (WOC) nursing. Can I bill Medicare and managed care payers directly for my specialized wound management services?

- JG, Florida

A: No. Becoming a board-certified WOC nurse may help you gain a wound specialist position at a higher pay rate, but it does not qualify you to bill Medicare directly. Medicare pays health care employers for wound management services by different methods:

• Hospitals are paid by the Diagnosis Related Group (DRG) payment system. Wound care services are included in the lump sum payment.

• Skilled nursing facilities are paid by the Resource Utilization Group (RUG) payment system. Wound care services are part of the all-inclusive payment.

• Home health care agencies are paid by the Home Health Resource Group (HHRG) payment system. Wound care services are included in this payment, which covers services provided for 60-day increments.

• Hospital-owned ...

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